NPIMap

Organization Active NPI

Sunshine Pediatric and Family Clinic LLC

  • Rural Health Clinic/Center
  • Breaux Bridge, LA
National Provider Identifier
1619618964
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SUNSHINE PEDIATRIC AND FAMILY CLINIC LLC
Practice address
555 Lakes Blvd
Breaux Bridge, LA 70517-3240
Phone
(337) 332-3971
Fax
(337) 735-3046
NPI assigned
Apr 1, 2022
Last updated
Jan 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Srinivasa Reddy Yerasi, MDNPI 1043529548
Title
Pediatrician
Phone
(337) 332-3971

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

555 Lakes Blvd
Breaux Bridge, LA 70517-3240

Mailing address

555 Lakes Blvd
Breaux Bridge, LA 70517-3240
Phone (337) 332-3971

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220517003049 LA Part B Supplier - Clinic/Group Practice 9436536265 Receives reassigned benefits from 8 practitioners
Practice locations: Breaux Bridge, LA
O20230301001881 LA Part A Provider - Rural Health Clinic 9436536265 Practice locations: Breaux Bridge, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619618964. Details of each certification follow.

Rural health clinic certification: CCN 198919

Legal name
SUNSHINE PEDIATRIC AND FAMILY CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 21, 2023
Last certification
Sep 21, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Mar 31, 2022 in LA
Enrollment address
555 Lakes Blvd
Breaux Bridge, LA 70517-3240

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2259423Sunshine Pediatric and Family Clinic LLC555 Lakes Blvd, Breaux Bridge, LA 70517Certificate of waiverMay 4, 2028

National Provider Directory

National Provider Directory

Locations

555 Lakes Blvd
Breaux Bridge, LA 70517
Phone (337) 332-3971

555 Lakes Blvd
Ste A
Breaux Bridge, LA 70517

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HBAHCD

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Srinivasa Reddy Yerasi Individual 5% Or Greater Direct Ownership InterestMember Nov 22, 2022 50%
Corporate OfficerPresident Nov 22, 2022
W-2 Managing EmployeePhysician Nov 22, 2022
Kiranmai Bandaru Individual 5% Or Greater Direct Ownership InterestMember Nov 22, 2022 50%
W-2 Managing EmployeePhysician Nov 22, 2022

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1619618964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 LAKES BLVD",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705173240",
            "telephone_number": "337-332-3971",
            "fax_number": "337-735-3046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 LAKES BLVD",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705173240",
            "telephone_number": "337-332-3971",
            "fax_number": "337-735-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE PEDIATRIC AND FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-01",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A",
        "authorized_official_last_name": "YERASI",
        "authorized_official_first_name": "SRINIVASA",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "337-332-3971",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Breaux Bridge, LA

Sources for this page

Verify at the official NPI Registry.